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Medical Case Manager and Bill Review in West Miami, FL at SNI Financial

Date Posted: 1/28/2020

Job Snapshot

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Job Description

SNI Companies is looking to hire a Medical Case Manager. The Medical Case Manager Primarily responsible for overseeing the care of the patient to ensure that treatment plan or protocol is within the standards established by the medical community. SNI Companies would like for the Medical Case Manager to have a minimum of 5 years of hands on simple-to-complex experience for this role.

The duties and responsibilities associated with the Medical Case Manager role are as follows:

  • Establish length of stay criteria for diagnosis. Familiar with evidence-based medicine, ICD 10, CPT, HPCS and other evidence-based clinical decision support solution
  • Establish and report cost estimate for the episode of care including PPO discount, if any.
  • Follow the episode of care every 48 hours or as needed with treating physician to ensure that patient is within the clinical protocols established for the diagnosis.
  • Report clinical and cost variances to the client for any conditions or special services items. Follows maternity care and pregnancies in accordance with ACOG guidelines and follows up with treating physician as needed as per ACOG.
  • Recommend alternate solutions to reduce cost without compromising patient comfort and quality of care.
  • Issues Pre-certifications based on policy, scope of benefits and policy terms and conditions. Uses proper referrals to proper sites for service, types of service and best discount and quality of care (MRI, Radiology, Psychiatric, Maternity)
  • Review interim bills concurrently and retrospectively to determine medical necessity and appropriateness.
  • Prepare logical and grammatically correct reports for hospital bill screening to healthcare providers and clients.
  • Negotiate challenges with healthcare providers in a professional and equitable manner efficiently and effectively.
  • Negotiate with non-participating providers to ensure clients continue to benefit from cost containment efforts.

Qualifications associated with the Medical Case Manager role consist of:

  • Demonstrates the ability to cooperate with others.
  • Demonstrates the ability to communicate with others.
  • Makes use of supervision appropriately.
  • Records complete, appropriate information in performing duties.
  • Demonstrates appropriate patient and customer relation skills by being considerate, courteous, helpful, sensitive, and compassionate to the needs of all whom we come in contact with during the work day.
  • Demonstrates good oral and written English skills in the performance of duties.

If you meet these qualifications and would like to be considered please send your resume to . SNI Companies is an equal opportunity employer.